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Find answers to your questions

Enrollment

An individual is eligible for a Special Enrollment Period (SEP). Do I need to submit anything to enroll them?

We require supporting documentation which outlines the specific SEP, and whether the Member qualifies. The required information may vary depending on the nature of the event.

If you are unsure what supporting documents you need to provide, please contact our Member Services Department for assistance at (855) 624-6463, select option 1, then choose option 5.

Tax Forms

When will I get my 1099?

1099 Forms are mailed out to brokers prior to the end of January each year.

Eligibility

What are your eligibility guidelines for group plans?

To be eligible as an Employer Group, there must be at least one eligible common law employee who is receiving a W-2, who is not an owner or spouse of an owner and is working a minimum of 30 hours per week. Sole Proprietors and groups composed only of an owner and spouse are not eligible for a group plan and must enroll on the Individual Market. An eligible group must be headquartered in Maine. They cannot have more employees in any other state than they have employed in Maine to be eligible for coverage with Community Health Options.

What is the difference between a Small Group and a Large Group?

Group size is determined by number of Full Time Equivalents (FTEs). An employer with 1 to 49 Full Time Equivalents is considered a Small Group and will be community rated. Any Employer Group with 50 or more Full Time Equivalents during the prior calendar year is considered a Large Group, and will receive premium rates based on the group’s claim experience and will be medically underwritten. Groups with 50 or more FTEs are also considered an Applicable Large Employer (ALE) by the IRS and are subject to specific reporting requirements. Visit the IRS website for more information about ALE reporting requirements.

How do I calculate the number of Full Time Equivalents?

To calculate the number of Full Time Equivalents (FTEs), you need to also consider your part time employees. Part time employees are those who work less than 30 hours per week. Add up the average number of hours worked per week of all part time employees for the previous calendar year, and divide by 30. Take the result and add the average number of full time employees (30 or more hours per week) that you had on payroll during the prior calendar year. This is your number of Full Time Equivalents. If you need assistance with the calculation, please send an email to businessdevelopmentinfo@healthoptions.org or call (207) 402-3353, to request an FTE calculator tool.

How many plans can an employer choose for their employees?

The number and variability of plans you may select for employees to choose from are limited by the number of enrolled employees.

  • 1 – 10 Enrolled Employees: 2 plan options, with no more than a $2500 spread in Deductible
  • 11 – 19 Enrolled Employees: 2 plan options, with no Deductible spread limitation
  • 20 or more Enrolled Employees: 3 plan options, with no Deductible spread limitation

Working With Us

I am taking over an existing Health Options client on a Broker of Record (BOR). What do I need to do?

In order for commissions to be paid to a new broker who is taking over an existing enrolled employer, the broker must obtain a signed Broker of Record Letter from the employer group and then submit the letter directly to your Account Manager in our Business Development Department to have the change processed.

When do you pay commissions?

Commissions are paid to appointed brokers no later than the end of the month for any commissions earned for the prior month.

What do I do if I have a question on my commissions?

Please email BusinessDevelopmentInfo@healthoptions.org, or call 207-402-3353.

How do I inquire about becoming appointed with Community Health Options?

Please contact our Business Development Department directly at 207-402-3353 or email BusinessDevelopmentInfo@healthoptions.org.

Who do I contact if my client has an issue that needs to be resolved?

If you need assistance with an Individual Member, please contact Member Services at 1 (855) 624-6463 then select option 1, then select option 5. For assistance with a Group client, please contact your Account Team in our Business Development Department at (207) 402-3353.

Who do I contact for assistance with the Broker Portal?

Please contact any Account Team Member in the Business Development Department at 207-402-3353.

An individual is eligible for a Special Enrollment Period (SEP). Do I need to submit anything to enroll them?

We require supporting documentation which outlines the specific SEP, and whether the Member qualifies. The required information may vary depending on the nature of the event.

If you are unsure what supporting documents you need to provide, please contact our Member Services Department for assistance at (855) 624-6463, select option 1, then choose option 5.

When will I get my 1099?

1099 Forms are mailed out to brokers prior to the end of January each year.

What are your eligibility guidelines for group plans?

To be eligible as an Employer Group, there must be at least one eligible common law employee who is receiving a W-2, who is not an owner or spouse of an owner and is working a minimum of 30 hours per week. Sole Proprietors and groups composed only of an owner and spouse are not eligible for a group plan and must enroll on the Individual Market. An eligible group must be headquartered in Maine. They cannot have more employees in any other state than they have employed in Maine to be eligible for coverage with Community Health Options.

What is the difference between a Small Group and a Large Group?

Group size is determined by number of Full Time Equivalents (FTEs). An employer with 1 to 49 Full Time Equivalents is considered a Small Group and will be community rated. Any Employer Group with 50 or more Full Time Equivalents during the prior calendar year is considered a Large Group, and will receive premium rates based on the group’s claim experience and will be medically underwritten. Groups with 50 or more FTEs are also considered an Applicable Large Employer (ALE) by the IRS and are subject to specific reporting requirements. Visit the IRS website for more information about ALE reporting requirements.

How do I calculate the number of Full Time Equivalents?

To calculate the number of Full Time Equivalents (FTEs), you need to also consider your part time employees. Part time employees are those who work less than 30 hours per week. Add up the average number of hours worked per week of all part time employees for the previous calendar year, and divide by 30. Take the result and add the average number of full time employees (30 or more hours per week) that you had on payroll during the prior calendar year. This is your number of Full Time Equivalents. If you need assistance with the calculation, please send an email to businessdevelopmentinfo@healthoptions.org or call (207) 402-3353, to request an FTE calculator tool.

How many plans can an employer choose for their employees?

The number and variability of plans you may select for employees to choose from are limited by the number of enrolled employees.

  • 1 – 10 Enrolled Employees: 2 plan options, with no more than a $2500 spread in Deductible
  • 11 – 19 Enrolled Employees: 2 plan options, with no Deductible spread limitation
  • 20 or more Enrolled Employees: 3 plan options, with no Deductible spread limitation

I am taking over an existing Health Options client on a Broker of Record (BOR). What do I need to do?

In order for commissions to be paid to a new broker who is taking over an existing enrolled employer, the broker must obtain a signed Broker of Record Letter from the employer group and then submit the letter directly to your Account Manager in our Business Development Department to have the change processed.

When do you pay commissions?

Commissions are paid to appointed brokers no later than the end of the month for any commissions earned for the prior month.

What do I do if I have a question on my commissions?

Please email BusinessDevelopmentInfo@healthoptions.org, or call 207-402-3353.

How do I inquire about becoming appointed with Community Health Options?

Please contact our Business Development Department directly at 207-402-3353 or email BusinessDevelopmentInfo@healthoptions.org.

Who do I contact if my client has an issue that needs to be resolved?

If you need assistance with an Individual Member, please contact Member Services at 1 (855) 624-6463 then select option 1, then select option 5. For assistance with a Group client, please contact your Account Team in our Business Development Department at (207) 402-3353.

Who do I contact for assistance with the Broker Portal?

Please contact any Account Team Member in the Business Development Department at 207-402-3353.

Broker Business Ad: Lobsterman (Color)

To add your logo to the ad, please click on the image box on the right side of the Community Health Options logo. Then browse your files for your logo and select okay.

Broker Business Ad: Lobsterman (B&W)

To add your logo to the ad, please click on the image box on the right side of the Community Health Options logo. Then browse your files for your logo and select okay.

Broker Business Ad: Good for Your Health (Color)

To add your logo to the ad, please click on the image box on the right side of the Community Health Options logo. Then browse your files for your logo and select okay.

Broker Business Ad: Good For Your Health (B&W)

To add your logo to the ad, please click on the image box on the right side of the Community Health Options logo. Then browse your files for your logo and select okay.

Broker Individual and Families Ad (Color)

To add your logo to the ad, please click on the image box on the right side of the Community Health Options logo. Then browse your files for your logo and select okay.

Broker Individuals & Families Ad (B&W)

To add your logo to the ad, please click on the image box on the right side of the Community Health Options logo. Then browse your files for your logo and select okay.

Coinsurance

Coinsurance is a percentage (for example 30%) you pay toward the cost of certain Covered Services. The plan will pay the remaining amount. Unless specified on your Schedule of Benefits, coinsurance begins once you have met your deductible.

Copayments (Copays)

A copayment is a fixed amount (for example, $15) you pay for a covered healthcare service, usually at the time you receive the service. Unless specified on your Schedule of Benefits, the deductible does not have to be met for the application of a copayment. The amount can vary by the type of covered healthcare service. Copayments do not count toward your deductible. Copayments do count toward your out-of-pocket maximum.

Covered Services

Covered services are the goods or services that the plan will help you pay as outlined in the Member materials. Your Member materials include the Member Benefit Agreement, Schedule of Benefits, and Summary of Benefits and Coverage.

Deductible

The deductible is the amount you pay for certain covered services before the plan pays benefits. If your plan covers more than one person, there will be both an individual deductible and a family deductible. Any one Member covered under your policy only needs to meet the individual deductible, while the other Members of your family combine to meet the remainder of the family deductible.

Out-of-Pocket Costs

Out-of-pocket costs are the costs you pay. Maximum out-of-pocket costs are the total of your copays, coinsurance, and deductible payments that you will be expected to pay.

Prescription Drug Formulary

We cover prescription medicines that are proven effective and list these drugs on a “formulary.” Go to HealthOptions.org/Formulary to see our complete formulary.

Primary Care Provider

Your Primary Care provider (or PCP) is a family doctor, nurse practitioner, pediatrician or other provider with whom you maintain a long-term relationship. Your PCP is a partner in your healthcare who will advise you and provide treatment on a range of health-related issues. He or she may assist you in your interactions with specialists.

Assistance with Open Enrollment 2019

This Community Health Options Webinar covers any questions you may have about healthcare open enrollment for 2019!

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Assistance with Open Enrollment 2019

This Community Health Options Webinar covers any questions you may have about healthcare open enrollment for 2019!

Workplace Drug Use and Testing in a New Era

With substance use rising across the nation and state of Maine, how should employers implement testing programs and cultures of clean workplaces?